Provider Demographics
NPI:1982627741
Name:ANDERLE, BRENDA H (PA)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:H
Last Name:ANDERLE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 HOSPITAL BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-2032
Mailing Address - Country:US
Mailing Address - Phone:940-641-3440
Mailing Address - Fax:940-641-3553
Practice Address - Street 1:1615 HOSPITAL BLVD STE A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-2032
Practice Address - Country:US
Practice Address - Phone:940-641-3440
Practice Address - Fax:940-641-3553
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00558363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1346542115OtherGROUP NPI NUMBER
TX8N8630OtherBLUECROSS BLUESHIELD
TX298439501Medicaid
1346542115OtherGROUP NPI NUMBER
TX8D1922Medicare ID - Type Unspecified